烧伤患者热量供应尚待探讨课题

How to evaluate energy requirement of burn patients a question still needs farther investigation

烧伤后分解、合成代谢均升高，分解代谢高于合成代谢，体内物质消耗加剧，而外源性营养物质不能完全纠正高代谢时机体消耗，营养底物在机体器官、组织、细胞的消化吸收转化受碍，底物堆积导致细胞、组织、器官代谢紊乱。

After a series of study of early feeding （EF） , we consider the evaporative heat loss from the burn wound is not the main mechanism of burn hypermetabolism. EF could resuscitate the intestine, preserve its structural integrity and function, prevent bacterial translocation and release of inflammatory mediators, reduce muscle protein catabolism and hypermetabolism. Our studies concerning the relationship between EF and hyper- metabolism have already extended to involve hypothalamus now. At the end of 1960s, the advancement in ＂ Intravenous Hyperali- mentation＂ has epoch-making significance,but it has been found later that energy has been oversupplied by this measure, thus it exacerbated visceral loading and led to disorder of internal envi- ronment,and it has been found not beneficial to alleviate hyper- metabolism. Whether ＂ hypocaloric nutrition＂ for post-operative patients of G-I （gastro-intestine） surgery is applicable to severe burn patients remains as a problem. Some specialists suggest it is better to supply 126-146 kJ·kg^-1·d^-1 in severe burn patients. After evaluating the bias and precision of 46 methods of estimating energy supply of burn patients reported from 1953 to 2000, Dikerson RN et al. concluded that the most precise,unbi- ased methods were those of Milner （1994） , Zawacki （1970） and TMMU （ 1993, Third Military Medical University formula）. Though formulas are simple and convenient to estimate energy supplementation, however, it is difficult to evaluate the requirement of energy when the patient＇s condition changes immensely.